Chapter 44- Common Endocrine Disorders. My Nursing Test Banks

 

1.

Hyponatremia without edema or hypovolemia is a sign of water intoxication caused by which of the following?

A)

Syndrome of inappropriate ADH secretion (SIADH)

B)

Diabetes insipidus (DI)

C)

Newly diagnosed type 1 diabetes

D)

Prerenal kidney failure

2.

Patients experiencing DKA (diabetic ketoacidosis) demonstrate a much higher level of ketoacidosis than patients experiencing HHS (hyperosmolar hyperglycemic state). Why does this occur?

A)

Patients with HHS produce just enough insulin to prevent ketosis.

B)

Only patients with Type 1 diabetes experience ketoacidosis.

C)

HHS develops too quickly to build up a high level of ketoacidosis.

D)

The fluid loss in HHS is too mild to allow a high level of ketoacidosis.

3.

Which of the following are precipitating factors for thyrotoxic crisis? Select all that apply.

A)

Infection

B)

Hypothermia

C)

Steroid therapy

D)

Long, chronic illness

E)

Pregnancy

4.

Which of the following descriptive words are indicative of myxedema coma?

A)

Rare, hypothyroid

B)

Chronic, hypothyroid

C)

Common, hyperthyroid

D)

Rare, hyperthyroid

5.

Sodium and osmolarity levels of both plasma and urine are helpful in the diagnosis of endocrine disorders. When serum sodium and serum osmolarity values are low while urine sodium and urine osmolarity are high, what is the most likely diagnosis?

A)

SIADH

B)

Diabetes insipidus

C)

Hypoglycemia

D)

Water intoxication

6.

Most endocrine disorders are not diagnosed until patients are acutely ill with a second condition. What are some common precipitating illnesses these patients may have?

A)

Severe illness/stress activating the HPA axis

B)

High glucose levels from gluconeogenesis

C)

Low cortisol levels from depleting the flight or fight response

D)

Decreased basal metabolic rate from prolonged hyperthermia

7.

A nursing plan of care for a patient in diabetic ketoacidosis (DKA) includes altered tissue perfusion. Why is this an appropriate nursing diagnosis?

A)

Decreased extracellular fluid volume leads to decreased tissue perfusion through anaerobic metabolism.

B)

Kussmauls respirations cause panting and water loss through evaporation.

C)

Ketoacidosis causes respiratory acidosis

D)

Low blood pH shifts the oxyhemoglobin dissociation curve to the left, causing poor tissue oxygenation

8.

A nursing plan of care for a patient who is hypoglycemic includes which of the following?

A)

Monitoring neurologic status changes

B)

Monitoring temperature status changes

C)

Monitoring cardiac status changes

D)

Monitoring blood alcohol levels

9.

A patient in HHS (hyperosmolar hyperglycemic state) has a serum glucose of 900, serum osmolarity of 400, and an anion gap of 8. Treatment for this condition includes which of the following?

A)

Administer intravenous normal saline as quickly as possible.

B)

Correct the fluid deficit with intravenous normal saline at a moderate rate.

C)

Administer a high-dose insulin drip.

D)

Administer sodium bicarbonate to correct the acidosis.

10.

A patient was resuscitated from a cardiopulmonary arrest and is now being managed with mechanical ventilation, an intravenous amiodarone drip, an angiotensin-converting enzyme (ACE) inhibitor, and a beta-adrenergic antagonist. The patient has severe tachycardia, tachypnea, diaphoresis, temperature above 104F, frequent premature ventricular contractions, clear lung fields, normal oxygen status, and agitation and restlessness. What complication and cause does the nurse suspect?

A)

Septic shock from ventilator-acquired pneumonia

B)

Hypovolemia from cardiopulmonary arrest

C)

Thyrotoxic crisis from amiodarone use

D)

Adverse reaction to ACE inhibitor

11.

A patient has been diagnosed with Graves disease. What physical symptoms would the nurse most expect to find?

A)

Bradycardia

B)

Diminished bowel sounds

C)

Alert and oriented times 3

D)

Exophthalmos

12.

The patient has been diagnosed with hyperthyroidism. What laboratory result would the nurse least expect to be elevated?

A)

Total thyroxine (T4)

B)

Free triiodothyronine (T3)

C)

Free thyroxine (T4)

D)

Thyroid stimulating hormone (TSH)

13.

A patient with hyperthyroidism is being treated with propylthiouracil and potassium iodide. When giving these medications, what precaution should the nurse take?

A)

Check apical pulse before administration.

B)

Check serum potassium before administration.

C)

Administer medications at least 1 hour apart.

D)

Give medications intravenously.

14.

A patient with severe thyrotoxicosis has a very high temperature. What medication or treatment is least appropriate to suppress the temperature?

A)

Acetylsalicylic acid (aspirin)

B)

Acetaminophen (Tylenol)

C)

Cooling blanket

D)

Intravascular cooling system

15.

A patient has been admitted to the critical care unit in myxedema coma. What patient description does the nurse most expect?

A)

Young man with abdominal trauma

B)

Middle-aged man with skeletal trauma

C)

Middle-aged woman in summer

D)

Elderly woman during winter

16.

A patient has been diagnosed with primary hypoadrenalism (Addisons disease). What usually destroys the adrenal gland tissues?

A)

Mycobacterium tuberculosis

B)

Septic shock hemorrhage

C)

Autoimmune antibodies

D)

Metastatic malignancies

17.

A patient has symptomatic adrenal insufficiency. What symptoms does the nurse most expect to find?

A)

Weakness and fatigue

B)

Constipation and increased appetite

C)

Bradycardia and bradypnea

D)

Weight gain and hypertension

18.

A patient is being evaluated for possible syndrome of inappropriate antidiuretic hormone (SIADH). What laboratory abnormality would the nurse most expect to find?

A)

Serum hyponatremia

B)

Serum hypokalemia

C)

Urine hyponatremia

D)

Urine hypo-osmolarity

19.

A patient has developed diabetes insipidus after suffering severe head trauma. What symptoms does the nurse expect to find?

A)

Urine output less than 30 mL/hr

B)

Urine specific gravity 1.001 to 1.005

C)

Serum osmolality below 275 mOsm/kg

D)

Serum sodium less than 135 mEq/L

20.

A patient in intensive care after a severe head injury has developed diabetes insipidus. What nursing assessment is the most important?

A)

Vital signs

B)

Cardiac pattern

C)

Fluid balance

D)

Level of consciousness

21.

For a patient with severe diabetic ketoacidosis, what treatment does the nurse expect to initiate?

A)

Large-volume intravenous crystalloid infusion

B)

Discontinuation of exogenous insulin

C)

Restriction of nutritional protein and fat

D)

Intravenous diuretic therapy

22.

A patient in diabetic ketoacidosis (DKA) is to receive insulin to control blood sugar. What type of insulin does the nurse expect to administer?

A)

Intravenous drip regular

B)

Subcutaneous regular

C)

Intravenous Lantis

D)

Subcutaneous Lantis

23.

A patient with type 1 diabetes mellitus is being discharged home after an episode of diabetic ketoacidosis (DKA). What should the nurse most emphasize in discharge teaching?

A)

Insulin therapy may be discontinued after several months.

B)

The patient needs supplemental insulin even when not eating.

C)

Blood sugar is best regulated by use of long-lasting insulin preparations.

D)

Blood sugar can be regulated by diet if the patient is very careful.

24.

A 40-year-old insulin-dependent diabetic is becoming increasingly stuporous. He is pale, diaphoretic, and tachycardic. What is the most important strategy the nurse expects to be included in the initial treatment?

A)

Low-dose insulin infusion

B)

Bolus of high-dose insulin

C)

Bolus of 50% dextrose

D)

Fluid replacement

25.

A middle-aged patient with diabetes mellitus type 2 is being treated for hyperosmolar hyperglycemic syndrome, which developed from an infection. During discharge teaching, the nurse emphasizes what concept?

A)

Reduce use of insulin when ill.

B)

Exercise moderately.

C)

Increase frequency of glucose testing when ill.

D)

Increase amount of carbohydrates in diet.

Answer Key

1.

A

2.

A

3.

A, B, C, D, E

4.

A

5.

A

6.

A

7.

A

8.

A

9.

B

10.

C

11.

D

12.

D

13.

C

14.

A

15.

D

16.

C

17.

A

18.

A

19.

B

20.

C

21.

A

22.

A

23.

B

24.

C

25.

C

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